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수술에 의한 요관 손상시 경피적 신루설치술과 체내 요관 스텐트 설치술의 유용성

Postoperative Ureteral Injury Treated by Percutaneous Nephrostomy and Ureteral Stent


Purpose : To evaluate percutaneous nephrostomy and ureteral stent placement in patients with postoperativeureteral injury. Materials and Methods : Percutaneous nephrostomy and antegrade ureteral stent placement wereattempted in 12 patients with postoperative ureteral injuries. The previous operations which caused ureteralinjuries included ureteroscopic extraction of ureteral stones(7), total abdominal hysterectomy due to uterinemyoma(2), ureteroscopic biopsy in a patient with ureteral tuberculosis(1), open ureteroplasty due toretroperitoneal fibrosis(1), and ureterocystostomy during renal transplantation(1). After percutaneousnephrostomy, a 7.0 F ureteral stent was inserted in each patient. The stent was removed under cystoscopic guidancefour to six weeks after this procedure. Urinalysis was performed to evaluate the presence of urinary tractinfection after ureteral stent placement. Ultrasonography and/or intravenous urography were performed three weeksafter stent placement, and every six months after the stent removal. Results : Percutaneous nephrostomy andplacement of an antegrade ureteral stent were successfully performed in all 12 patients. In three patients, thediagnosis of ureteral injuries was made immediately and in nine was delayed for between two and nineteen days. Theureteral stents remained in position for 25-95 days (average, 51) ; no evidence of urine leakage or ureteralstricture was seen on the follow-up examinations carried out from six months to several years after removal of thestent and no case required reintervention. Conclusion : Percutaneous nephrostomy and antegrade ureteral stentingare easy to perform, provide for the drainage of urine, cause no significant complication and show a successfultherapeutic effect, and are this effective non-operative interventional techniques for patients with postoperativeureteral injury.

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참고문헌 (16)

  1. 경피신루설치술 , 박재형;김승협;한만청 , 대한방사선의학회지 / v.26,pp.1090-1095, 1990
  2. 경피신루설치술 , 류인훈;류국현;김재규;박진균;강형근;정현대 , 대한방사선의학회지 / v.26,pp.1090-1095, 1990
  3. Percutaneous nephroureteral drainage and stenting for postsurgical ureteral leaks , Druy EM , AJR / v.141,pp.389-394, 1983
  4. Antegrade ureteral stenting for dehiscence, stricture, and fistulae , Lang EK , AJR / v.143,pp.795-801, 1984
  5. latrogenic ureteral injury , Dowling RA;Corriere JN;Sandler CM , J Urol / v.135,pp.912-915, 1986
  6. 경피 체내 뇨관 스텐트 설치술 , 김승협;박재형;한준구;한만청 , 대한방사선의학회지 / v.26,pp.1068-1072, 1990
  7. Stone formation as a complication of indwelling ureteral stent : a report of 5 cases , Spirnak JP;Resnick MI , J Urol / v.134,pp.349-351, 1985
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  9. 경피 인공 뇨관 설치술 , 윤엽;성동욱;최우석(등) , 대한방사선의학회지 / v.25,pp.871-875, 1990
  10. Perforation of renal pelvis by internal ureteral stents , Salazar JE;Johnson JB;Scott RL , AJR / v.143,pp.816-818, 1984
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  12. Ureteral injuries , Lang EK;Pollack HM(ed.) , Clinical Urography: An atlas and textbook of Urological Imaging(1st ed.) / v.,pp.1495-1504, 1990
  13. Pyelonephritis from severe encrustations of silicone ureteral stents : management , Abber JC;Kahn RI , J Urol 183 / v.130,pp.763-764, 0000
  14. Shearing of percutaneous nephrostomy catheter during indwelling ureteral stent placement , Sussman SK;Oke EJ;Perlmutt LM(et al.) , AJR / v.147,pp.832-833, 1986
  15. Diagnosis and management of ureteral fistulas by percutaneous nephrostomy and antegrade stent catheter , Lang EK , Radiology / v.138,pp.311-317, 1981
  16. Placement of ureteral stents by antegrade and retrograde technique , Mitty HA;Train JS;Dan SJ , Radiol Clin North Am / v.24,pp.587-600, 1986

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